Magdalena Kuzelova

The use of medications with anticholinergic properties and risk factors for their use in hospitalised elderly patients

The aims of the present study were to evaluate the use of drugs with anticholinergic properties in elderly patients and to identify risk factors that increase the patients chance of being given such medications.

Alcohol intoxication requiring hospital admission in children and adolescents: retrospective analysis at the University Children's Hospital in the Slovak Republic

Background. Few epidemiological studies have investigated the problem of children and adolescents taken to hospital with acute alcohol intoxication. Methods. We reviewed the medical records of children and adolescents aged ≤ 18 years hospitalized with alcohol intoxication alone in the University Childrens Hospital in Bratislava, Slovak Republic, during the years 1996–2005 and compared their characteristics between the first and the second 5-year time periods. Results. 537 patients (273 boys and 264 girls) were admitted to the hospital with intentional acute alcohol intoxication (1.5% of all admissions and 34.2% of all intoxications) between 1996 and 2005. The average age of the patients with alcohol intoxication presenting to hospital was 15.1 ± 1.7 and the youngest were 9-year-old children. The proportion of children admitted with alcohol intoxication increased every year (R2 = 0.935) (p < 0.001). The average blood alcohol concentration was 1.98 ± 0.57 g/L, and it increased in 2001–2005 in relation to the previous 5 years (p < 0.001). The highest estimated alcohol concentration (4.39 g/L) was found in the blood of a 17-year-old boy. The mean poisoning severity score was 1.53 ± 0.61 and had increased in line with blood alcohol concentration for the years 2001–2005 (p < 0.001). Conclusions. The results of this analysis emphasize the severity of underage alcohol consumption by young people in the Slovak Republic. Measures are needed to decrease alcohol abuse in children and adolescents.

Factors influencing the use of potentially inappropriate medication in older patients in Slovakia.

Background:  Although increasing attention has been given to the evaluation of use of potentially inappropriate medication in the older European Union (EU) member countries, information on this topic from Central and Eastern Europe is scarce.

Adverse drug reactions related to hospital admission in Slovak elderly patients

The aims of the present study were: to evaluate the prevalence of adverse drug reactions (ADRs) leading to hospitalization in elderly patients; to analyze the drugs which have been identified as having causal relationship with ADRs and to identify risk factors which predispose the patient to such ADRs. The study has been performed in 600 patients aged> or =65 years, hospitalized in a general hospital between 1 December 2003 and 31 March 2005. The ADRs recorded in patients documentation as one of the reasons for hospital admission were evaluated. ADRs leading to hospital admission were recorded in 47 (7.8%) patients. ADRs in 43 patients represented A-type ADRs which are preventable. The most frequent ADRs were cardiovascular disorders. According to the results of multivariate analysis ischemic heart disease (odds ratio (OR)=4.50; 95% confidence interval (CI)=1.36-14.88), depression (OR, 2.49; 95% CI, 1.08-5.77) and heart failure (OR, 2.08; 95% CI, 1.13-3.81) were the most important patient-related characteristics predicting ADRs leading to hospitalization. The majority of ADRs in elderly patients could be avoided. Regular re-evaluation of the medication as well as taking into account the specific features of elderly patients represent the most important tools for ADR prevention.

Serum cystatin C level for better assessment of glomerular filtration rate in cystic fibrosis patients treated by amikacin

Background and objective:  Monitoring of renal function in cystic fibrosis (CF) patients is essential. The dosage regimen of amikacin is regularly modified according to the patient’s glomerular filtration rate (GFR). The aim of the study was to evaluate the use of cystatin C (CyC) for monitoring amikacin therapy along with other markers of renal tubular and glomerular function, and damage [N‐acetyl‐β‐d glucosaminidase (NAG), creatinine level and creatinine clearance].

Off-label and unlicensed use of medicinal products in the neonatal setting in the Slovak Republic.

Frequent prescription of medication in an unapproved manner (off‐label or unlicensed) in the neonatal setting is a result of the limited availability of adequately studied drugs in the pediatric population. Given that little information is available on this issue from eastern European countries, the purpose of this study was to describe for the first time the extent and pattern of off‐label or unlicensed use of medicines in newborns in the Slovak Republic.

The effectiveness of daily SMS reminders in pharmaceutical care of older adults on improving patients’ adherence to antihypertensive medication (SPPA): study protocol for a randomized controlled trial

BackgroundDespite a variety of efficient and cost-effective antihypertensive medication, hypertension remains a serious health and economic burden. High consumption of cardiovascular drugs in the Slovak Republic does result neither in better hypertension control nor in significant decrease in cardiovascular mortality. At the same time, Slovakia has alarmingly low patients’ adherence to medication intake. Studies have shown the efficiency of short messaging service (SMS) reminders to improve patients’ adherence and health outcomes at low costs. Since SMS is popular among Slovaks, this approach may be feasible also in Slovakia. The primary objective is to assess if daily SMS reminders of antihypertensive medication intake provided by pharmacists in addition to the standard pharmaceutical care increase the proportion of adherent older hypertensive ambulatory patients.MethodsThe SPPA trial is a pragmatic randomized parallel group (1:1) trial in 300 older hypertensive patients carried out in community pharmacies in Slovakia. Trial pharmacies will be selected from all main regions of Slovakia. Trial intervention comprises daily personalized SMS reminders of medication intake embedded into usual pharmaceutical practice. The primary outcome is a combined adherence endpoint consisting of subjective self-reported medication adherence via the eight-item Morisky Medication Adherence Scale (MMAS-8) and objective pill count rate. Secondary outcomes include: change in the MMAS-8; comparison of adherence rates using pill count; change in systolic blood pressure; and patient satisfaction. Also, direct treatment costs will be evaluated and a cost-effectiveness analysis will be carried out.DiscussionThe SPPA trial engages community pharmacists and mobile health (mHealth) technologies via evidence-based pharmaceutical care to efficiently and cost-effectively addresses current main healthcare challenges: high prevalence of hypertension; overconsumption of cardiovascular medicines; low adherence to medication treatment; and resulting uncontrolled blood pressure. The results may identify new possibilities and capacities in healthcare with low additional costs and high value to patients.Trial registrationClinicalTrials.gov, NCT03105687. Registered on 07 March 2017.

The effect of selected patient's characteristics on the choice of antihypertensive medication in the elderly in Slovakia †

The aim of the present study was to determine which patient‐related characteristics influence the selection of the antihypertensive drug class in elderly patients in Slovakia.

Adolescents’ knowledge and perception of medicine risk

Adolescents often start to use medicines independently without having sufficient knowledge or previous experience, which can lead to the inappropriate use of medicines.

Caustic Ingestion in the Elderly: Influence of Age on Clinical Outcome

Caustic poisonings are still associated with many fatalities. Studies focusing on the elderly are rare. The purpose of the present study was to compare the clinical outcomes of caustic ingestion injury in elderly and non-elderly adults with regard to gender, intent of exposure, substance ingested, severity of mucosal injury, complications, and mortality. Caustic substance exposures reported to the National Toxicological Information Centre in Slovakia during 1998–2015 were reviewed retrospectively. The patients were divided into two groups: the non-elderly (<60 years) and elderly adults (≥60 years). The mortality rate in the elderly was significantly higher (elderly 23.0% vs. non-elderly 11.3%; p = 0.041). The risk of fatal outcome in the elderly was increased by acid ingestion (OR = 7.822; p = 0.002), particularly hydrochloric acid (OR = 5.714, p = 0.006). The incidence of respiratory complications was almost two times higher in the elderly was 31.1% vs. 17.4% for the non-elderly (p = 0.037). Respiratory complications significantly correlated with an increased mortality rate (p = 0.001) in the elderly whereas there was no association between GI complications and mortality in the elderly (p = 0.480). Elderly patients with respiratory complications had the poorest clinical outcomes. The highest risk of complications and fatalities was observed in patients after hydrochloric acid ingestion.